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Santangeli and colleagues' meta-analysis (1) evaluating the effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death among young and elderly patients concluded that available data do not definitively show that ICDs improve survival in elderly patients. We agree with the authors that these findings have important clinical implications and might support the theory that cardiac resynchronization therapy alone may be the best device therapy for elderly (>65 years) patients with severe left ventricular dysfunction. However, we would like to raise several points that may shed additional light on the findings and implications of this meta-analysis.